Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 75 (1), 1329

Pain Neuroscience Education: Which Pain Neuroscience Education Metaphor Worked Best?


Pain Neuroscience Education: Which Pain Neuroscience Education Metaphor Worked Best?

Adriaan Louw et al. S Afr J Physiother.


Background: The use of pain neuroscience education (PNE) has been shown to be effective in reducing pain, improving function and lowering fear and catastrophisation. Pain neuroscience education utilises various stories and metaphors to help patients reconceptualise their pain experience. To date no individualised study has looked at which stories and metaphors may be the most effective in achieving the positive outcomes found with the use of PNE.

Objectives: This study examined patient responses to the usefulness of the various stories and metaphors used during PNE for patients who underwent surgery for lumbar radiculopathy.

Method: Twenty-seven participants who received preoperative PNE from a previous randomised control trial (RCT) were surveyed 1-year post-education utilising a 5-point Likert scale (0 - 'do not remember', 4 - 'very helpful') on the usefulness of the various stories and metaphors used during the PNE session. Participant demographics and outcomes data (pain intensity, function and pain knowledge) were utilised from the previous RCT for analysis and correlations.

Results: Nineteen surveys were returned for a response rate of 70%. No story or metaphor mean was below 2 - 'neutral', lowest mean at 2.53; 6 of the 11 stories or metaphors scored a mean above 3 - 'helpful'.

Conclusion: No individual story or metaphor stood out as being predominately important in being helpful in the recovery process through the use of PNE.

Clinical implications: The overall messages of reconceptualising pain during PNE may be more important than any individual story or metaphor.

Keywords: chronic pain; lumbar radiculopathy surgery; metaphors; pain neuroscience education; physiotherapy; survey.

Conflict of interest statement

Adriaan Louw, Emilio J. Puentedura, Ina Diener, and Kory J. Zimney have published books on pain neuroscience education and receive royalties from them.


Example of picture to explain ‘extra-sensitive alarm’.
Example of picture to explain ‘hospital experiences’.
Rating of the pain neuroscience education metaphors (0 = cannot remember; 4 = very helpful).

Similar articles

See all similar articles


    1. Blasini M., Corsi N., Klinger R. & Colloca L., 2017, ‘Nocebo and pain: An overview of the psychoneurobiological mechanisms’, Pain Reports 2(2), e585 10.1097/PR9.0000000000000585 - DOI - PMC - PubMed
    1. Diener I., Kargela M. & Louw A., 2016, ‘Listening is therapy: Patient interviewing from a pain science perspective’, Physiotherapy Theory and Practice 32(5), 356–367. 10.1080/09593985.2016.1194648 - DOI - PubMed
    1. Gallagher L., Mcauley J. & Moseley G.L., 2013, ‘A randomized-controlled trial of using a book of metaphors to reconceptualize pain and decrease catastrophizing in people with chronic pain’, The Clinical Journal of Pain 29(1), 20–25. 10.1097/AJP.0b013e3182465cf7 - DOI - PubMed
    1. Keulers B.J., Scheltinga M.R., Houterman S., Van Der Wilt G.J. & Spauwen P.H., 2008, ‘Surgeons underestimate their patients’ desire for preoperative information’, World Journal of Surgery 32(6), 964–970. 10.1007/s00268-008-9581-1 - DOI - PMC - PubMed
    1. Landers M.R., Puentedura E., Louw A., Mccauley A., Rasmussen Z. & Bungum T., 2014, ‘A population-based survey of lumbar surgery beliefs in the United States’, Orthopaedic Nursing/National Association of Orthopaedic Nurses 33(4), 207–216. 10.1097/NOR.0000000000000064 - DOI - PubMed

LinkOut - more resources